Hims Hard Mints are chewable tablets sold through the telehealth platform Hims that contain two erectile dysfunction (ED) drugs in a single dose: sildenafil (the active ingredient in Viagra) and tadalafil (the active ingredient in Cialis). They are marketed as a mint-flavored alternative to traditional ED pills, designed to dissolve in the mouth rather than be swallowed whole with water. The product is prescription-only, meaning a licensed prescriber must authorize it after a health assessment, but that assessment typically happens online rather than in a doctor’s office. What makes the product unusual is the combination of two drugs that are normally prescribed separately, and the chewable format itself raises practical questions about absorption, timing, and whether the experience actually differs from swallowing a standard pill.
What Is Actually in Them
Each Hard Mint contains two active pharmaceutical ingredients from the same drug class, called PDE5 inhibitors. Sildenafil is a short-acting drug: it kicks in relatively quickly and wears off within several hours. Tadalafil is a long-acting drug with a much longer presence in the body, sometimes lasting over a day. The idea is that combining the two gives you both a relatively fast onset and a wider window of effectiveness. The mint flavoring and chewable format are added on top of that, largely for convenience and to mask the bitterness that PDE5 inhibitors are known for. Pharmaceutical and food manufacturers have long worked on physical approaches to suppress bitterness in the mouth, using structures that bind bitter compounds in saliva and break down after swallowing.
Both sildenafil and tadalafil work through the same basic mechanism. During arousal, the body releases nitric oxide, which triggers a chain of chemical events that relaxes smooth muscle in blood vessels supplying the penis. PDE5 is an enzyme that breaks down a key molecule in that chain. By blocking PDE5, these drugs let that molecule accumulate, which keeps blood vessels relaxed and makes it easier to achieve and maintain an erection. This pathway has been the foundation of ED treatment since sildenafil was introduced in the late 1990s.1Europe PMC. PDE5 inhibitors – pharmacology and clinical applications 20 years after sildenafil discovery The drugs do not cause an erection on their own; sexual stimulation is still required to initiate the process.
Why Two PDE5 Inhibitors Instead of One
Combining a short-acting and a long-acting PDE5 inhibitor in a single product is not a Hims invention, but it is not standard practice in mainstream urology either. The rationale has been explored in clinical research, particularly for men who do not respond well to a single drug on its own. A study of 180 men with ED found that daily low-dose tadalafil combined with sildenafil as needed produced better erectile function scores than tadalafil alone, with the biggest improvements seen in men with severe ED, and with no increase in side effects between the two groups.2PubMed. Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction
A commentary in JAMA Network Open argued that combining daily tadalafil with an on-demand PDE5 inhibitor could have an additive effect and might even be considered as a first-line strategy in more advanced cases of ED, rather than reserved as a last resort.3JAMA Network Open. Combination Therapies for Erectile Dysfunction—A Synergy of Modalities Holds the Key Separately, research presented at a sexual medicine conference concluded that the combination of long-acting and short-acting PDE5 inhibitors was both effective and safe in patients who had not responded to PDE5 inhibitors used alone, and that this approach could serve as an alternative before moving to more invasive treatments like injections or surgical implants.4The Journal of Sexual Medicine. Efficiency and Safety of Combining Long-Acting and Short-Acting PDE5 Inhibitors
That said, combining two drugs from the same class is not something most urologists routinely do. The research supporting it exists but is still relatively thin compared to the mountains of data behind each drug used individually. The Hard Mints product takes this combination approach and packages it as a consumer-friendly product, which is a step beyond what most published studies have tested in terms of specific formulations and doses.
Does the Chewable Format Change How the Drug Works
One of the selling points of a chewable or dissolvable tablet is the suggestion that it gets into your system faster than a pill you swallow. There is some logic to this: the tissues in your mouth have a rich blood supply, and drugs absorbed through the oral mucosa can bypass the digestive tract and liver on their initial pass through the body. Whether Hard Mints deliver a meaningfully faster onset than a swallowed pill depends on how much of the drug actually absorbs through the mouth versus how much you end up swallowing with saliva. Hims has not published independent pharmacokinetic data comparing their chewable mint to a standard oral tablet, so the speed-of-onset question remains somewhat unresolved for this specific product.
What is well established is that food has a big impact on how quickly sildenafil works when taken orally. A study on sildenafil oral films found that eating a meal delayed the time to peak blood levels by about an hour and a half and cut peak concentration roughly in half, even though the total amount of drug absorbed over time was similar.5PubMed Central. Food effect on pharmacokinetic profiles of sildenafil 100 mg oral films in healthy male volunteers: results from two randomized, single dose, crossover studies This matters because if you take a chewable product but still swallow most of the drug, eating beforehand could delay and blunt its effect just like a traditional tablet. Tadalafil, by contrast, is much less affected by food, which is one reason it pairs well with sildenafil in a combination product: even if the sildenafil component gets slowed down by a meal, the tadalafil component provides a longer, steadier background effect.
Common Side Effects
Because Hard Mints contain the same active drugs found in Viagra and Cialis, the side effects are essentially the same as those drugs. An analysis of the World Health Organization’s global safety database for PDE5 inhibitors found that the most frequently reported side effects were headache (about 10% of reports), visual changes (about 8%), flushing (about 5%), and indigestion (about 4%).6PubMed. Adverse reactions of PDE5 inhibitors: An analysis of the World Health Organization pharmacovigilance database These rates are broadly consistent across the different PDE5 inhibitors, and a comparative review has noted that sildenafil, tadalafil, and vardenafil all have similar efficacy and side-effect profiles.7PubMed. Comparison of phosphodiesterase type 5 (PDE5) inhibitors
Headache deserves special mention because it is the side effect men most often notice. Roughly one in four men prescribed sildenafil experiences headaches, and in some cases these can be migraines or even cluster headaches.8PubMed Central. Sildenafil can induce the onset of a cluster headache bout Since Hard Mints contain both sildenafil and tadalafil, it is reasonable to wonder whether doubling up on PDE5 inhibitors increases headache risk. The studies on combination therapy did not report a higher rate of side effects compared to monotherapy, but those studies used specific dose ranges and may not perfectly mirror the doses in a consumer product.
Other less common but more serious effects include a sudden drop in blood pressure, especially if you are dehydrated or on certain medications. Rare but well-known risks include prolonged erection lasting more than four hours (priapism), sudden hearing changes, and a form of vision loss called non-arteritic anterior ischemic optic neuropathy. These are rare enough that they do not show up prominently in most clinical trials but are listed on every PDE5 inhibitor’s prescribing information.
Who Should Avoid Them
The most critical safety concern with any PDE5 inhibitor is the interaction with nitrate medications, commonly prescribed for chest pain (angina). Nitrates and PDE5 inhibitors both cause blood vessels to relax, and combining them can produce a dangerous, potentially fatal drop in blood pressure. This is an absolute contraindication, meaning there is no safe way to use the two together, though the required waiting period between doses varies depending on whether the PDE5 inhibitor is short- or long-acting.9PubMed. A New Perspective on the Nitrate-Phosphodiesterase Type 5 Inhibitor Interaction
A large study of men with stable coronary artery disease put hard numbers on this risk: those using PDE5 inhibitors alongside nitrate medications had about 39% higher overall mortality, a 72% higher rate of heart attack, and a 70% higher rate of major cardiovascular events compared to those not combining the two drug types.10PubMed. Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors The fact that Hard Mints contain two PDE5 inhibitors rather than one does not change this interaction, but it does mean there is no safe “half-dose” workaround: if you take nitrates, the product is off limits entirely.
Beyond nitrates, men taking alpha-blockers for prostate enlargement or blood pressure should exercise caution, as the combination can also lower blood pressure. People with severe liver or kidney problems, unstable heart conditions, or a history of stroke should discuss PDE5 inhibitor use with a physician who can review their full medical picture rather than relying solely on an online questionnaire.
How the Telehealth Prescribing Process Works
Hims is part of a broader wave of direct-to-consumer telehealth platforms that prescribe ED medications online. The typical process involves filling out a health questionnaire, which is then reviewed by a licensed prescriber. A study examining 15 of these platforms found that the vast majority started with an online form, and about two-thirds advertised review by the prescriber within two business days. Only about a quarter explicitly offered physician-only consultations, and at over half the platforms, direct contact with the prescriber by phone or video happened only when needed or required by state law.11PubMed Central. Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment
The convenience is real. Privacy concerns, embarrassment, and difficulty accessing in-person appointments are frequently cited as reasons men avoid seeking ED treatment, and online platforms lower those barriers substantially. But the tradeoff is a less thorough medical evaluation. The American Urological Association’s guidelines for ED include counseling patients that erectile dysfunction may signal underlying cardiovascular disease. Direct-to-consumer platforms are limited in their ability to screen for this, or for other underlying causes such as hormonal imbalances, neurological conditions, or psychological factors. Without a physical exam or lab work, some diagnoses could be missed, and a man’s ED could be treated symptomatically while a more serious condition goes undetected.12PubMed Central. Direct-to-Consumer Erectile Dysfunction Medications: is the Convenience Worth the Cost?
This does not mean telehealth-prescribed ED medication is unsafe for most men. For someone who is otherwise healthy, has no cardiac risk factors, and is not on conflicting medications, the questionnaire-based process is likely adequate. The concern is more about what might be missed: ED in a 45-year-old man who thinks he just needs a pill could occasionally be an early warning sign of heart disease, diabetes, or low testosterone that warrants in-person investigation.
What Hard Mints Cost Compared to Alternatives
Convenience and branding come with a price premium. A comparison study of direct-to-consumer ED pharmacies found that introductory sildenafil packages at Hims started at about $26 per month for four pills, working out to roughly $6.50 per pill. Tadalafil packages started at $30 per month for four pills, or about $7.50 each. By comparison, the same generic drugs purchased through a cost-plus pharmacy ran about $0.32 per pill for sildenafil and $0.36 per pill for tadalafil, representing a markup of roughly twenty times for the same active ingredients.13The Journal of Sexual Medicine. (163) The High Price of Anonymity: Comparison of Cost of Direct-to-Consumer Mail Order Pharmacies Compared with Cost Plus Drug Company
Hard Mints, as a proprietary combination product, are priced at a further premium above those single-ingredient introductory packages. The exact cost varies depending on the subscription plan and dose selected. You are essentially paying for the combination formulation, the chewable format, the telehealth consultation, the discreet packaging, and the brand itself. Whether that bundle of conveniences is worth the markup depends on your budget and how much you value the streamlined experience versus visiting a doctor and filling a generic prescription at a local or online pharmacy.
Most insurance plans do not cover ED medications purchased through direct-to-consumer platforms, though some cover generic versions obtained through traditional pharmacies with a prescription from an in-person provider. If cost is a primary concern, getting a prescription for generic sildenafil or tadalafil through your regular doctor and filling it at a discount pharmacy will almost always be cheaper than any DTC subscription service.
ED Treatment in Younger Men
One reason products like Hard Mints exist is that the population seeking ED treatment has shifted. Erectile dysfunction is no longer just a concern for older men. Research estimates that somewhere between 14% and 30% of men under 40 experience some degree of ED, and the number of younger men seeking treatment has been rising. A retrospective study found that from 2016 to 2024, an average of 521 men aged 40 or younger sought ED consultations annually at the studied institution.14The Journal of Sexual Medicine. (188) Profiling Erectile Dysfunction in Men Under 40: A Retrospective Study of Psychogenic and Organic Etiologies and Emerging Treatment Trends
Younger men are also more likely to seek treatment online. The product design of Hard Mints, from the branding to the chewable format to the subscription model, is clearly aimed at a younger, digitally comfortable demographic that may never have discussed ED with a physician. This is both the strength and the limitation of the product: it reaches men who would otherwise go untreated, but it also normalizes a pharmacological approach to what might, in younger men, have psychological or lifestyle-related causes that a pill will not address.
Roughly 30% of men do not respond adequately to PDE5 inhibitors used on demand, for both psychological and physical reasons, and discontinuation rates for these drugs remain high regardless of the delivery format. A chewable mint does not change the underlying pharmacology, and a man whose ED is primarily driven by performance anxiety, relationship stress, or depression may find that medication alone is not enough. For some, the fact that the treatment “looks different” from a traditional pill may provide a small psychological boost, but the active ingredients and their limitations remain the same.
The Taste-Masking Challenge
PDE5 inhibitors are intensely bitter compounds, which is why standard tablets are film-coated and designed to be swallowed quickly. A chewable product that sits in your mouth for 30 seconds or longer presents a genuine formulation challenge. The pharmaceutical industry has developed various physical strategies to mask bitterness, typically by encapsulating the bitter compound in micro- or nanostructures that prevent it from dissolving in saliva while still releasing the drug after swallowing. The degree of bitterness suppression depends on how much of the active ingredient is free in the saliva at any given moment.
Hard Mints use mint flavoring and sweeteners to cover the taste, and consumer reviews are mixed on how well this works. Some users describe a pleasant mint flavor with a slightly medicinal aftertaste; others find the bitterness noticeable. This is a minor point in terms of clinical effectiveness, but it matters for adherence: if a product tastes bad, people stop using it. The traditional pill-swallowing approach sidesteps the taste problem entirely, which is one reason most generic ED medications have not moved to chewable formats despite the theoretical absorption advantages.
When an In-Person Visit Is Worth It
For a man with no significant health issues who has occasional difficulty with erections and wants a convenient, discreet option, Hard Mints or similar telehealth-prescribed ED products are a reasonable choice. But several situations call for an in-person evaluation instead. If you have known heart disease, take blood pressure medications, have diabetes, or have noticed a gradual decline in libido alongside erectile problems, a physician can order blood work and a physical exam that an online questionnaire cannot replace. ED that comes on suddenly, that is accompanied by pain, or that occurs alongside urinary symptoms may point to conditions requiring different treatment entirely.
Men who have tried PDE5 inhibitors without success also benefit from in-person care. A urologist can explore whether the dose is right, whether an underlying vascular or hormonal issue is limiting the drug’s effectiveness, or whether non-pharmacological approaches like vacuum devices, pelvic floor therapy, or counseling might be more appropriate. The online model works well as a first step for straightforward cases, but it is not designed to manage ED that does not respond to standard medication or that reflects a more complex medical picture.